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SLOW MEDICAL TREATMENT IN YOUR CASE – Maryland Workers Compensation

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Delayed medical treatment under Maryland workers compensation

In some cases there are extensive and repetitive delays in obtaining medical treatment through workers compensation insurance.  The delayed medical treatment may arise because of the Employer and Insurer’s rights which may inadvertently place the injured workers rights on hold.  Like the injured, the Employer/Insurer have certain rights under the workers compensation laws.

If your medical treatment or doctors appointments have been put on hold so that workers comp can schedule an Independent Medical Evaluation with their doctor you should not wait to take action. 

Contact Maryland Workers Compensation Attorney Andrew M. Rodabaugh for a free consultation!

For a no cost consultation with Anne Arundel County workers comp Attorney Andrew M. Rodabaugh call  +1 (410) 937-1659  , Email ,  or fill out the form at the bottom of this page.

 

Workers Comp may delay or deny medical treatment so they can obtain a Second Opinion or Independent Medical Evaluation (IME)

The Employer/Insurer does not legally have to accept the treating physicians recommendation whether it be for surgery, injections, pain medication, physical therapy or other treatment.  They are entitled to obtain an Independent Medical Evaluation (IME) from a doctor of their choosing before willingly paying for the treating physicians recommendation which results in a treatment delay.  Under Maryland workmans comp laws the treatment must be “reasonable, necessary, and causally related” to the accident at work.  This phrase opens up a door to differing opinions and creates the proverbial gray area which provides both the injured worker and workers comp argument leverage over the medical treatment and whether it is related to the actual work incident.  What is reasonable to Doctor X may not be reasonable to Dr. Y and what is necessary to Dr. X may not be necessary to Dr. Y.  Also, Dr. X and Dr. Y can disagree as to what is causally related to the accident.

When an IME is scheduled it is time to obtain a Maryland workers compensation attorney.

Independent Medical Evaluations and delays or denials in getting medical treatment in workers compensation cases

More often then not, the delays in treatment are related to the workers comp Insurer’s right to have an IME performed.  The workers comp adjuster will wait until he or she receives the IME report before approving the treatment recommended.  IME’s are often scheduled a month or two out and the medical reports can take another few weeks to be issued.  If this delay in medical treatment is not aggravating enough in the event the IME Doctor indicates that the medical treatment is not reasonable, is not necessary, is not causally related, or any combination of these requirements then the delay in treatment continues.  When the adjuster denies treatment, or if it is expected that treatment will be denied once the IME is performed, a hearing before the Maryland Workers Compensation Commission will need to be requested.  Unfortunately hearings are not held as soon as everyone in the workers compensation community would like and this will again delay the treatment and the conclusion of the case.

It is important to realize that in many Maryland Workman’s Compensation cases there are numerous IME’s performed which may lead to numerous delays.  It is not uncommon for an IME to be scheduled and performed based on the reasonableness of some form of treatment recommendation like physical therapy, and soon after a second IME is being performed to determine if another form of treatment is reasonable like an MRI.  It is important to know what to expect at the IME.

Legal procedures delaying workers compensation medical treatment

Once a hearing request is filed with the Maryland Workers Compensation Commission the legal process of obtaining the denied medical treatment begins.  Sometimes this is referred to as appealing the adjuster. (See the appeal process)  The waiting period fluctuates for the workers compensation hearing but typically hearings are set-with in three months ultimately delaying medical treatment further.  The reasons for the waiting period are comparable to the reasons one must wait for any Government agency or department to act. Often referencing bureaucratic restrictions, budgetary restraint, or excess citizen demand.  Occasionally the hearings can be placed on a docket longer than three months, and seldom within one month.  Assuming it took two months for the IME to be performed and another three months for the hearing before the Maryland workers compensation commission, the injured employee could expect to wait five months for a determination of whether the work comp insurer will be responsible to pay for the medical treatment.  It is best not to assume a five month wait and prepare for a longer period.

Legal delays can also materialize if there is a need for a postponement or continuance of the scheduled hearing.  When the case is continued the hearing will typically Workers Compensation Lawyerbe reset within two months however occasionally it is sooner.  The basis of a qualifying continuance request are numerous and can arise from any party involved in the case including potential witnesses, attorney’s, or, very rarely the Workers Comp Commission.

The best way to prevent delays in the treatment process is to hire a qualified and experienced Baltimore workers compensation attorney early in the process.

Can you avoid delays of medical treatment in workers compensation cases?

Each and every workers compensation case is different in almost every regard but especially when dealing with the consistency of medical treatment.  On occasion there are injured workers that never have to deal with delays with medical treatment in their workers compensation case.  However, most do have some sort of hang up with obtaining authorization for a consultation with a physician or a medical procedure with a provider.  To expedite medical treatment authorization it is helpful to be pro-active.  Do not assume the doctors office is requesting approval from the adjuster.  Don’t assume the doctor’s office properly requested authorization for medical treatment from the workers compensation adjuster.  It is a good idea to follow up on treatment requests even if there is a nurse case manager assigned to the case or the treating provider has indicated they have requested authorization.

In the event an IME is scheduled it is highly unlikely medical treatment will be authorized before the scheduled evaluation.  An option is to discuss treatment approval through a health insurer rather than the workers comp insurer.  When requesting treatment from a health insurance policy it is important the health insurance company is aware that there is a pending workers compensation case with an IME scheduled.

In rare circumstances when workers comp delays medical treatment the injured employee is willing to pay out of pocket for the medical treatment. Rather than wait for an IME to be performed or for a hearing to take place the injured worker may pay out of pocket if financially doable and permissible according to the doctors office policy.  Injured workers should take care to pay for medical treatment according to the workers compensation fee schedule rather than health insurance rates or the doctors billing rates.

See Also:

Neither Health Insurance nor Workers Comp will Pay

Delays in payments may also be expected.

 

For a no cost consultation with Anne Arundel County workers comp Attorney Andrew M. Rodabaugh call  +1 (410) 937-1659  , Email ,  or fill out the form at the bottom of this page.

 

Mr. Rodabaugh is a valuable asset to his community.  His continuing dedication to the law and his clients is admirable.
Adam SPersonal Injury Attorney

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